Rom J Morphol Embryol 2015, 56(2):521–525 ISSN (print) 1220–0522 ISSN (on-line) 2066–8279 CASE REPORT Tuberculosis of the oral cavity ROXANA MARIA NEMEŞ 1) , EDITH SIMONA IANOŞI 2) , CORINA SILVIA POP 3) , PARASCHIVA POSTOLACHE 4) , COSTIN TEODOR STREBA 5) , MIHAI OLTEANU 5) , ANDREEA-LOREDANA GOLLI 6) , MĂDĂLINA OLTEANU 7) , MIMI FLOAREA NIŢU 5) 1) Department of Complex Functional Investigations, “Marius Nasta” Institute of Pulmonology, Bucharest, Romania 2) Department of Pulmonology, University of Medicine and Pharmacy of Tirgu Mures, Romania 3) Emergency University Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 4) Department of Pulmonology, “Grigore T. Popa” University of Medicine and Pharmacy, Iassy, Romania 5) Department of Pulmonology, University of Medicine and Pharmacy of Craiova, Romania 6) Department of Public Healthcare and Management, University of Medicine and Pharmacy of Craiova, Romania 7) Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Romania Abstract Tuberculosis (TB) of the tongue is not a common finding diagnosis, even if consider endemic areas. Tuberculosis of the tongue sometimes can mimic lingual neoplasm. Oral tuberculosis is rarely primary as mechanism, and frequently secondary to pulmonary tuberculosis. There are many suspect lesions that can be classified as tuberculosis, such as tumor mass, ulcerative lesion or fissure. It is very important for diagnosis to perform histopathological examination of the biopsy. We present here the case of a 74-year-old man who developed lingual tuberculosis with a tumor aspect concomitant with pulmonary tuberculosis. Histopathological and immunohistochemical examinations established the diagnosis of lingual tuberculosis. Keywords: oral ulcers, tongue tuberculosis, tumor mass, histopathological examination.  Introduction Primary tuberculosis (TB) of the oral cavity, including tongue, is very rare because of continuous cleaning of oral mucosa by saliva and absence of lymphoid follicles in tongue [1–3]. Secondary tuberculosis of oral cavity is 0.2 to 1.5% of extrapulmonary tuberculosis cases [4, 5]. The most common locations are: pleural TB, lymphadenitis TB, osteoarticular TB, vertebral TB, urogenital TB, TB pericarditis, peritoneal ascites TB, gastrointestinal TB, laryngitis TB, meningitis TB (with or without miliary TB) [6]. There are many factors that can contribute in oral tuberculosis lesions, such as long-term smoking, less oral hygiene or different oral traumas. Local clinical exam, a good anamnesis, histopathological exam are very important for the diagnosis. Golden standard for diagnosis is per- forming histopathological exam of the biopsy from the suspect lesion. Aim We present here the case of a 74-year-old man who presented with an ulcerative tumor of the tongue, in whom the histopathology and immunohistochemistry exams were positive for lingual tuberculosis.  Case report A 74-year-old men, worked in a foundry, toxic environ- ment for 25 years (SiO 2 ), was presented in September 2012 in the outpatient department and was diagnosed with community pneumonia left upper lobe (LUL), after a routine chest X-ray, being without clinical symptoms. Patient comes from low socioeconomic status; he is a chronic smoker 60 pack-years and occasional alcoholic. On examination, patient was well built with good general condition. Despite the administration of antibiotics, the radiolo- gical lesions remain unmodified, showing ulcerous homo- geneous opacities, which tend to conflate found on the LUL and Fowler segment. Between September 2012 and March 2013, no data was found concerning the patient. In March 2013, due to an ENT (ear, nose, and throat) service check-up, he was diagnosed with ulcerated tumor of the tongue. Examination of oral cavity revealed an ulcerated lesion, about 1.5 cm involving right lateral border of tongue, whitish, opaque with smooth surface and well- defined margins. Other examination of oral cavity and larynx was normal. There was no cervical lymphadenopathy. A month later, while being hospitalized, surgery with excision of the tumors lump tongue was performed. Biopsy of the ulcer was taken, which showed granulomatous inflammation, suggestive of tuberculosis: a multitude of granulomatous nodes deep muscle layer, made of epithe- lioids nodes and multinucleated Langhans giant cells, same with central necrosis, partially looking effusion, ultra- infected with a tendency to confluence (Figures 1–3). Trichrome staining revealed the presence of intense collagen fibrosis within the epithelial erosion zones (Figure 4) and within the tuberculosis node (Figure 5). In order to emphasize specific inflammatory cells, in the paraffin-embedded material, we have performed serial R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/